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Keller Canyon ❑ Ox mountain ❑ Newby Island ;,0 Forward , <br /> fi <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone (650)726-1819 Phone (408) 945-2800 Phone (209)982-429J <br /> Fax (925) 458-9891 Fax (650) 726-9183 Fax (408)262-2871 Fax(209) 982-10� <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR' t <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP. , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> tt �wArJ T- r f ` <br /> PHONE Q GLOVES L]GOGGLES Q RESPIRATOR O HARD HAT <br /> LI TY VEK ❑OTHER <br /> CONTACT PERSON, <br /> I ; ; k t f SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the California code of regulations has been properly <br /> desenbed clasalfted and packagod and is to proper condition for transportation a-cordrng to applicable <br /> regulations AND,it the waste 1s a treatment residue of a prevlousty restricted hazardous waste <br /> subject to the Land Disposal Restnctions i certify and warrant that the waste has been treated in RECEIVING FACILITY , <br /> accordance with the requirements of 40 CFR Part 268 and is longer ger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL Ll SLUDGE <br /> Q CONSTRUCTION ID WOOD <br /> L]DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> vi <br /> TRANSPORTED NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS - e 1 <br /> CITY, STATE,ZIP <br /> PHONE "r 1 r I W END DUMPY BOTTOM DUMP -- TRANSFER1:1 Ur <br /> ' <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN 'DRUMS <br />� CUBIC YARDS OEM <br /> ' <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) ' <br /> is true and accurate <br /> DISPOSE OTHER <br /> REMARKS ❑SOIL ' <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER ti DEBRIS ' <br /> U NON-FRIABLE <br /> ti <br /> SIGNATURE OF AUTH RIZED AGENTS DATE ASBESTOS <br /> f O WOOD <br /> f <br /> fmay, r,jdo <br /> Q ASH t O SPECIAL OTHER <br /> r <br /> 00115 <br /> SCHEDULING MUST BE MALE PRIORT0 3 00 PM TIME DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVIERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> UAMj==CT# A *4 A Q q <br />